听神经瘤术中电生理监测预测术后面神经功能的研究  

Prediction of facial nerve function by electrophysiological monitoring during operation of acoustic neuroma

作　　者：陈立科[1] 周玲 张雨涵[1] 潘心怡 赵业禹[1] 李美华[1] Chen Like;Zhou Ling;Zhang Yuhan;Pan Xinyi;Zhao Yeyu;Li Meihua(Department of Neurosurgery,the First Affiliated Hospital of Nanchang University,Nanchang City,Jiangxi Province,330000,China)

机构地区：[1]南昌大学第一附属医院神经外科,南昌市330000

出　　处：《现代电生理学杂志》2022年第4期201-206,共6页Journal of Modern Electrophysiology

摘　　要：目的:探讨在听神经瘤手术中经颅电刺激面神经运动诱发电位(TceFNMEP)、瞬目反射(BR)和电流刺激等电生理监测指标对预测术后面神经功能的作用。方法:采用前瞻性队列研究方法,选择2016年1月至2021年1月于南昌大学第一附属医院神经外科行听神经瘤切除术的患者135例,术后采用House-Brackmann分级评估面神经功能。对这些患者的临床资料、术中电生理监测指标、面神经解剖保留率、术后面神经功能状况进行整理和分析。结果:135例患者中,术后面神经解剖保留者124例(91.9%)。术后随访1年,面神经功能保留者110例(81.5%,110/135例)。面神经功能保留组和未保留组,肿瘤囊变、TceFNMEP波幅、TceFNMEP最小刺激量、面神经脑干端波幅、面神经脑干端和内听道端的波幅比、面神经脑干端刺激阈值等比较,差异有统计学意义(P<0.05)。将以上变量行多因素Logistic回归分析,结果显示肿瘤囊变和面神经脑干端刺激阈值是术后1年面神经功能保留的独立相关因素。结论:肿瘤囊变与面神经脑干端刺激阈值是预测术后面神经功能的重要指标。Objective:To investigate the effects of transcranial electrical stimulation facial nerve motor evoked potential(TceFNMEP),blink reflex(BR)and electrical stimulation on predicting postoperative facial nerve function during acoustic neuroma surgery.Methods:A total of 135 patients who underwent acoustic neuroma resection in Department of Neurosurgery of the First Affiliated Hospital of Nanchang University from January 2016 to January 2021 were enrolled in the study.The facial nerve function was evaluated by House-Brackmann grading after the operation.The clinical data,intraoperative electrophysiological monitoring indexes,facial nerve anatomical retention rate and postoperative facial nerve function were analyzed.Results:Among 135 patients,124 patients(91.9%)retained the facial nerve anatomy after operation..After 1 year follow-up,the facial nerve function of 110 patients was preserved(81.5%,110/135 cases).There were significant differences in tumor cystic degeneration,the amplitude of facial nerve induced by the same amount of TceFNMEP,the minimum amount of TceFNMEP at the end of operation,the amplitude of facial nerve exiting from brainstem,the amplitude ratio between brainstem and internal auditory canal,and the stimulation threshold of brainstem between the preserved and non-preserved groups(P<0.05).Multivariate logistic regression analysis of the above variables showed a statistical significance of tumor cystic change and brainstem end stimulation threshold,confirming that they were independent related factors of facial nerve function retention at one year after surgery.Conclusion:Tumor cystic change is a factor affecting the postoperative facial nerve function,the retention of facial nerve function is more difficult when the tumor develops cystic change.The stimulation threshold of facial nerve in brainstem end at the end of the operation is an independent related factor to predict the postoperative facial nerve function,and the smaller the stimulation threshold,the better the function of the postoperative fac

关 键 词：神经瘤 听 面神经 诱发电位 运动 电刺激 瞬目反射 

分 类 号：R739.4[医药卫生—肿瘤]